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a�sasaoozo City of Zephyrhills Permit Application Fax-813-780-0021
<br /> Bullding Department
<br /> -a - • :.
<br /> Date�ece�ved - ° .�'/,`�. 78� _ SDl�
<br /> - • Phone�Confact',for�P�rmlttin
<br /> Own�r's Name �reco �� p. Owner Phone Nlumber � � "-/ O p���'�O �
<br /> Owner's Address ��v �LL/n , �D/'' /_�_ Own�r Phone Numb�r�
<br /> Fee Simple TItleFioldec Name � Owner Phone Numb�r
<br /> -:�r. - -
<br /> Fee Simple Tltleholder,Addresa .
<br /> JOB ADOttESS ��o� j� [�i� ���,, jp , ��
<br /> LOT#
<br /> sueoivosiow . .. = P�ce�io# _/�.� �� 0"7l� �1D1� �Dd�l� Do2c�d
<br /> . � (OBTAINED F.ROM:PROPERTY,TAX NOTICE)
<br /> WORK PROPOSED ._;NEW CONSTR ADD/ALT �� SIGN' 'Q � � Q =DEMOLISH
<br /> B_ INSTALL � ,f ftEPAIR � _
<br /> PROPOSED�U$E . . � Q SFR. [� COMM . � Q •OTHER '
<br /> TYPE OF CON3TRUCTION`< Q" -r'BLOCK r Q FRANIE ` ,� STEEL 'Q
<br /> , •,. -
<br /> DESCRIPTION OF WORK' �, �CNS, r7 C C�/Q-a1I C�°- O u � p � �� � '��+
<br /> BUILDING�SIZE,' , . - �'`' '
<br /> 'SQ�FOOTAGE ' I1ElGHT,
<br /> �. , - �
<br /> QBUILDING $ VALUATION-OF'TOTAL CONSTRUCTION ' `
<br /> QELECTRICAL $ " AMP SERVICE. � �.Q �PROGRE$S ENERGY [� W.R:E:C.
<br /> QI?LUMBIIVG $ - . � � ,/, � �
<br /> �����. � �� � � / li
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<br /> OMECHANICAL $ /�/� ` VALUATION O.FIMECHANICAL INSTALWTION:
<br /> ' .. ��VV r �� , . ' ., , ., ,. . ... , , � � .
<br /> Q�S Q ROOFING Q ,,- SPEGIALT�IC,.�] .�._.OTHER�;-, _
<br /> FINISHED FLOOR ELEVATIONS FLOOD�ONE ARE�► ,QY�S. ,NO
<br /> . .., :- . . .. �,,- .. , � . , .
<br /> ••�_ ,S" `r�_ r.�' :�..: _
<br /> BUILDER COMPANIF�.. ._._ �_:..G��..,�:- -=� s � .�.....-_ �.. ,
<br /> SIGNATURE REGISTERED Y/ N . �����F.EE CURRE� p Y/'N -
<br /> .. '��37:. :cF,' . .:-'S' _��'� - .,. ..� . . ., . .
<br /> Address �.: ,, . ;a .� °Llcense}#� - ,
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<br /> ' ,.. .. , , <. -r, •r= -' ' ,� ,. . _ . ,. ., . ... : -- �
<br /> ELECTRICIAN; ,. ,.. . . - �jCOMPANY;' ;�,' t���: ,a3.���.�.,-,;_.�= r:� ._ . - :
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<br /> SIGNATURE 7 ' REGISTERED Y/ N F.EE CURREI�9� �'�:=-Y/=N_�. .�� '
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<br /> Address� ' -. .' - • .�.;License;#� . "
<br /> . . .., . , ' F;�� " , _
<br /> PLUMBEPt ` .. • ` ' C.OMPANY � ..:•�.>;: .0 .,�.•_t. --- ,, . . ,
<br /> SIGNATURE`;'V�� ��`� � ` � `REGI§TERED �Y../,.N;; ..,EEE:CuwtErt` ^Y�/.N.� .
<br /> Address , � -. � _ � _ ' -VLfcense.#;* _ . . � .. , ,.
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<br /> �aecwwica: >> ,. �{-����, . ' coMPi►rnr, �:��f�2 S. `��oA-iv��-5't ����=��
<br /> SIGNATURE' `'- - _ , • � -- �
<br /> FtEGISTERED : Y;/,N � FEE CURRE�,=, Y./rN"_;.
<br /> _r .. _, . ... , -, , _ -
<br /> Addr�sa;-4..,:�:�:�:�}�I G'� ����GS�"�. ��� � ' � � Llcense#`,.�/�-c� '6���/ �O ..
<br /> _.,. ' � . ,. . . _ .-.�. . . . '_ , , . . �;�.y.��`.y., .
<br /> OTHER +'�,. � . _•.t _ �• •- , . ` ;` - � �;COMPANY.;:. , , n•.. , . , , , , ..
<br /> SIGNATURE� _ '�F• �" • �'' '��' °` " 'REGISTERED ' ' "Y/"f)F.:.w. �;FEE�CURRE�'�`� Y�/N. _
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<br /> �' s.. i.�� I :+� ..� - .._.. _. . _ " . - . . . . ' .
<br /> l�lddre�s :w�:. ,:,�� _ . :�:�.�.� . ' " 'License#��` � . , � , _
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<br /> RESIDENTIAL"-?,�AttacFi. 2 P1ot;Plans 2 ': '�; `�• '_�
<br /> �;;,�< <,(_);� ;;( )set's=:o'f.:BuAilirig?Plan`s;'(.1)set'ofEnergy�Forms,��R=0=V1/'Per`init far-new construcNon, �� ` , ,.�
<br /> �-�, >Minimumq�enr(�1,0)•wrorlfing;da�ys�aiter�"sabmitital'�date�:J�,equlreil onslte;:Constroctlon'Plans;��Stomiwate�'Rlans w/Silt Fence'installed, '
<br /> .. �`� , �:. � o. -
<br /> �SenitaryFaclllUe,s,-&:;1<<dumpster��Slte�.W,orlriPermit,for:sutjdivi'sions/le[ge'oproJ'e,',otsM:�µ�<=��;,�tik ,;' .�, _ '
<br /> CO[VINIERCIAL Attach(3)�coiiiplete'sets°'of'Buildtng'Plans'`plus`a�Life S�a`fety Page;(1)set of Energy Forrns.R-O-W'Permtt for neW construction.- • � _
<br /> Minimum ten.(10)working days after submittal date. Requtred onsite,ConsUuction Plans,Stormwater Plans w/Silt Fence installed,
<br /> - Sanitary Facilttles&1 dumpster.Stte Work Permit for all naw;projects:=i411 commerctal_requirements.must meet compliance �� � �
<br /> SIGN PERMIT AttacFi'(2)sets of�Eng,i`nee,Fed;Pla�is:;�. ,-., �v`~ _: �..- � ;t��- . _ . .� , "- ' . , ,
<br /> ""PROPERTY SURVEY requlred_for all NEW�construcUon._ _ _ -
<br /> Dlr`ections: _:,.;�;,+.,._,: ..__
<br /> FIII out epplicaUon completely.
<br /> Owner 8 Contractor slgn back of appltcaUon,notarized
<br /> If over�,2500,_a,Notice of�Commencement la requlred. (AfC upgrades over 37500) ,
<br /> H ;'��=:�fi�7:;',r�i�.��. ,
<br /> Agent(for tFie conVaictqr)or:Power"of Attoiney(for the owner)�wiould�be�somecne with notarized letter from owner authorizing same
<br /> DVER�THE..COUN•T.ER_PERNNT'1�N('$"=.�'��(R�``o,�O�"f,='/�"`�,"p1�'�t�in" �"'='� �" ' �`� °
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<br /> Reroofs If shingles S8W 3'ScBNICA t?pgre�es�/�I,C � FenCes Iot/Survey/Footage) •����`�-�������.+� �«����., _
<br /> _..,,._.._ .,:�ViILt{'i t4'_9ih'S. _�ttit.:SL`f..t,l,f•:U �.s"�� i4'' - ��'o;%J��'30 b3Ei� .11dbh', `��n �`�-, _ _ "
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<br /> Drivewaya-NotoverCo tertlf�ahFP�iblic`�ro�eduvAy�::needs�0 �• °f„`r'� s a�.�'r f+t�sCt��x� �7;�?y�; _. °(/ 4�_
<br /> �i£rt�;.ii�4? � tiC?i7E:!t�Eiic"..� .`',..�t��:• v�St�F{i 7�'8 �1nii:?Et3l�TiQ� �?,° er�,`�:
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<br /> .ft{tis�2LL,E��SR?;tar�f!�!luil??G:•bf•f$ ''=i�i�ii���',
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